No-Fault Case Law

The court considered the fact that the provider had previously submitted claims to arbitration following a motor vehicle accident involving the same assignor. The arbitrator found that the provider had failed to prove its standing to sue, and dismissed the claim without prejudice to the right to initiate a new arbitration with supplementary proofs. Despite this, the provider commenced an action in the Civil Court to recover assigned first-party no-fault benefits. The main issue decided was whether the provider had waived its right to commence an action to litigate its claims by electing to arbitrate them. The court held that the provider had waived its right, and that the Civil Court properly granted summary judgment dismissing the complaint. Therefore, the order entered May 18, 2015 was affirmed, and the appeal from the order entered May 26, 2016 was dismissed.

The court considered the fact that the plaintiff, a provider, was seeking to recover assigned first-party no-fault benefits from the defendant. The defendant had moved for summary judgment to dismiss a portion of the complaint, claiming it was premature because the plaintiff had failed to provide requested verification. The main issue decided was whether the defendant had properly mailed verification requests and whether the plaintiff had received the requested verification. The court decided that there was a triable issue of fact as to whether the portion of the action seeking to recover the sum of $3,399.51 was premature, and therefore reversed the order and denied the branch of defendant's motion seeking summary judgment to dismiss that portion of the complaint.

The relevant facts considered by the court were that Charles Deng Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits from Zurich American Insurance Company. The main issue decided was whether Zurich American Insurance Company had issued an insurance policy covering the loss in question. The holding of the court was that the proof submitted by the defendant was sufficient to demonstrate that they had not issued a policy covering the loss in question. As a result, the court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment dismissing the complaint. The order was affirmed with costs.

The main issue in this case was whether the defendant was entitled to summary judgment dismissing the complaint on the ground that the plaintiff had failed to appear for duly scheduled examinations under oath (EUOs). The court found that to establish its entitlement to summary judgment, the insurer must demonstrate, as a matter of law, that it had twice duly demanded an EUO from the provider, that the provider had twice failed to appear, and that the insurer had issued a timely denial of the claims. The plaintiff in this case did not challenge that the defendant demonstrated its prima facie entitlement to summary judgment, but rather argued that the plaintiff raised a triable issue of fact in opposition. However, the court found that the plaintiff's argument lacked merit and therefore granted defendant's motion for summary judgment, dismissing the complaint. The holding of the court was that the order of the Civil Court, insofar as appealed from, is reversed and defendant's motion for summary judgment dismissing the complaint is granted.

The court considered the facts that Island Life Chiropractic, P.C. was seeking to recover first-party no-fault benefits and that State Farm Mutual Automobile Insurance Co. had denied the claims on the grounds that the plaintiff's assignor had failed to appear for scheduled examinations under oath. State Farm had mailed initial and follow-up letters scheduling the examinations and the plaintiff's assignor had failed to appear on either date. The main issue decided was whether State Farm's motion for summary judgment dismissing the complaint should be granted. The holding of the case was that as the plaintiff failed to raise a triable issue of fact in opposition to State Farm's motion, State Farm was entitled to summary judgment dismissing the complaint. Therefore, the order was reversed and State Farm's motion for summary judgment dismissing the complaint was granted.

The court considered the fact that the defendant had first learned of the accident on the date it had received an NF-2 form, which had been submitted more than 30 days after the accident had occurred. The denial of claim forms further advised the plaintiff that late notice would be excused if reasonable justification for the failure to give timely notice was provided. The main issue was whether the defendant had established its prima facie entitlement to judgment as a matter of law in a case by a provider to recover assigned first-party no-fault benefits. The holding of the case was that the order denying defendant's motion for summary judgment dismissing the complaint was reversed, with $30 costs, and the defendant's motion for summary judgment dismissing the complaint was granted.

The relevant facts considered by the court in this case were that plaintiff's assignor, Sharise Davis, was seeking payment of no-fault insurance benefits for medical treatment received as a result of an automobile accident. Plaintiff was seeking judgment in the amount of $425 plus interest. Defendant denied the claims based on the policy. The main issue was whether the plaintiff was entitled to payment under the no-fault law and the policy, and if defendant's motion for summary judgment and dismissal of the complaint should be denied. The court decided in favor of the defendant, holding that plaintiff's claims were precluded by a provision of the insurance policy limiting coverage to the "legal representative of the deceased" and that the defendant had failed to submit admissible evidence in support of its claim.

The court considered the fact that the defendant, 21st Century Centennial Ins. Co., had moved for summary judgment to dismiss the complaint filed by Urmas Medical, P.C., as the assignee of Hensley Dupigny, in a case to recover assigned first-party no-fault benefits. The main issue decided was whether the defendant's motion for summary judgment was timely, as it had been filed more than 120 days after the notice of trial had been filed, in violation of CPLR 3212(a). The holding of the case was that the defendant's motion for summary judgment was untimely, as it did not demonstrate good cause for not filing the motion within the required timeframe, and the Civil Court had improvidently exercised its discretion in entertaining the motion after considering the good cause arguments raised by the defendant for the first time in its reply papers. Therefore, the order granting the defendant's motion for summary judgment was reversed, and the motion was denied.

The court considered the defendant's motion to dismiss the complaint based on the doctrine of res judicata or, in the alternative, for summary judgment. The plaintiff, a chiropractic medical center, had commenced an action to recover first-party no-fault benefits for medical services provided to a patient injured in a 2010 automobile incident. The defendant insurer had also filed a declaratory judgment action in Supreme Court, seeking a determination that the plaintiff was not entitled to no-fault benefits for the 2010 collision. The Supreme Court had granted the insurer's motion on default, issuing an order that declared the plaintiff was not entitled to benefits. In the current no-fault action, the defendant insurer moved to dismiss on the grounds that the Supreme Court's order precluded the current action based on res judicata. The plaintiff argued that the default judgment did not have preclusive effect under New York state law and cited various federal and state cases for support. The court held that under res judicata, a disposition on the merits bars litigation of a cause of action between the same parties arising out of the same transaction. The court also clarified that under New York state law, default judgments that have not been vacated are final orders and have preclusive effect. The court distinguished the plaintiff's cited cases and held that the specific declaratory judgment order in this case, which had been granted on default, constituted a conclusive final determination and precluded the current no-fault action. In conclusion, the court granted the defendant's motion to dismiss, holding that the action was dismissed due to the preclusive effect of the Supreme Court's declaratory judgment order.

The court considered the defendant-insurer's motion for summary judgment to dismiss the complaint. The main issue decided was whether the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that it timely denied the plaintiff's first-party no-fault claims based on a sworn independent examination report (IME) of its examining acupuncturist/chiropractor. The holding of the case was that the defendant-insurer did make a prima facie showing of entitlement to judgment as a matter of law. The court reversed the order of the Civil Court, granted the motion for summary judgment, and dismissed the complaint. The court found that the plaintiff's opposition to the motion for summary judgment did not raise a triable issue, as the affidavit of the plaintiff's principal was not based on an examination of the assignor and did not rebut the findings of the defendant's examining acupuncturist/chiropractor.